Engaging in Healthcare May Close Longevity Gap Between Black and White Men With HIV

WASHINGTON -- For men who have sex with men and are living with HIV, adopting strategies that would further engage Black men with the healthcare system could potentially close the gap in longevity between Black and white men, researchers suggested here.

Using the framework of the HIV Care Continuum, simulation modeling showed that engagement with the healthcare system and yearly HIV testing could reduce the 6.3-year gap in the life expectancy status quo by more than a year between Black (52.2 years from age 15) and white men (58.5 years), reported Katherine Rich, MPH, of Harvard Medical School in Boston, during her presentation at IDWeek.

Rich said that if all men were tested for HIV, that would translate into a 0.6-year gain in life expectancy for Black men and a 0.3-year gain for white men.

Since the continuum of care starts with testing, the downstream effects would increase the number of men who become engaged in the healthcare system, and then further would increase the number of those who achieved viral suppression, which would improve life expectancy.

Overall, these strategies would translate into a 3.4-year gain in life expectancy for Black men and a 1.6-year gain in life expectancy for white men, which would cut into the longevity gap, Rich said.

Co-author Emily Hyle, MD, MSc, of Harvard Medical School and Massachusetts General Hospital, noted that "there are significant and unacceptable disparities in HIV care. Black men who have sex with men in the United States do not experience the same health outcomes as white men who have sex with men."

"Equity-focused solutions combatting structural barriers to care are essential to reduce disparities and improve outcomes," she added.

Christian Sandrock, MD, of the University of California Davis in Sacramento, told MedPage Today that "having underrepresented minorities engaged in healthcare has always been a challenge. Some of that is cultural, some of that is healthcare structure, and this group, African-American men who have sex with men and have HIV, carries an additional burden of stigma."

He explained that improved engagement with the healthcare community might involve finding clinicians who the patient is more comfortable with, such as a person of similar race or ethnicity or sexual orientation.

"In our diverse community in Sacramento, we often find that having someone from the same community talk with the patients may make a big difference in keeping that person engaged in the healthcare system," Sandrock said. "This is very complex."

For this study, Rich and colleagues used the validated Cost-Effectiveness of Preventing AIDS Complications (CEPAC) model to project life expectancy among Black and white men who have sex with men and have HIV, using estimated average ages at HIV infection of 26.8 years for Black men and 35.0 years for white men, and estimated time from infection to diagnosis (3.4 years and 3 years, respectively).

They also used race-stratified data from the CDC, calibrating input parameters for race-specific estimates for the proportion of men who were retained in healthcare and those who attained viral suppression to account for differences in the HIV Care Continuum.

In the model, Rich and colleagues estimated that 90% of white men who have sex with men are tested to determine their HIV status compared with 82.7% of their Black counterparts. In the continuum of care, that translated to 72.5% of white men being retained in healthcare compared with 62.1% of Black men, and 66.2% versus 51%, respectively, achieving viral suppression.

Rich and colleagues acknowledged that their study focused on health outcomes among men with HIV and did not simulate transmissions. Furthermore, their results reflect national data, and not local HIV Care Continuum frameworks that might be significantly different.

Comment